Ethnoracial Risk Variation Across the Psychosis Continuum in the US: A Systematic Review and Meta-Analysis

Area of Science:

• Psychiatry
• Public Health
• Epidemiology

Background:

• Existing research indicates a higher risk of schizophrenia diagnoses in Black Americans compared to White Americans.
• A comprehensive investigation into ethnoracial disparities across the psychosis continuum, including multiple outcomes and groups, is lacking.

Purpose of the Study:

• To systematically identify variations in ethnoracial risk for three key outcomes on the psychosis continuum in the United States.
• Outcomes examined include schizophrenia and other psychotic disorders, clinical high risk for psychosis (CHR-P), and psychotic symptoms (PSs) and psychotic experiences (PEs).

Main Methods:

• A systematic review and meta-analysis of observational studies were conducted, searching PubMed, PsycINFO, and Embase up to December 2022.
• Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were followed, employing a random-effects model to pool estimates and assess heterogeneity and risk of bias.

Main Results:

• The meta-analysis included 47 studies (54,929 individuals for schizophrenia; 223,097 for PSs/PEs).
• Compared to White individuals, Black individuals showed increased risk for schizophrenia (OR, 2.07) and PSs/PEs (SMD, 0.10).
• Latinx individuals had higher risk for PSs/PEs (SMD, 0.15), and other ethnoracial groups had higher schizophrenia risk (OR, 1.81). Asian individuals showed elevated schizophrenia risk in inpatient settings (OR, 1.84) and increased PEs in college samples (SMD, 0.16). CHR-P results were inconsistent.

Conclusions:

• Widespread ethnoracial risk variation exists across multiple psychosis outcomes in the US.
• Beyond diagnostic and measurement biases, systemic factors like structural racism are critical drivers of these disparities.
• Further research is needed to address heterogeneity and bias in existing studies.